Treatment: Medical Options
If it is discovered that the stenosis of the artery is significant - more than 70 percent of the artery is blocked - your doctor will discuss treatment options. These may include medications and supplements, as well as dietary and lifestyle changes, to aggressively reduce the factors for atherosclerosis. As stated, this involves minimizing the risk factors of atherosderosis. Common standard therapy includes lifestyle modification and dietary changes. Your doctor will be checking your cholesterol profile and will be very aggressive in treatment.
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| Treatment Chronic Kidney Disease |
Tight control of blood pressure and blood sugars is very important, as is lowering of homocysteine levels and promoting a lower level of inflammation in the body. (Yes, this can be done!)
The Angiogram
One imaging procedure that was not mentioned before is the angiogram. Although it is considered by doctors - including nephrologists and vascular surgeons - to be the "gold standard" in diagnosing stenosis of occluded vessels like the arteries going to the kidney, it is not without its risk.
Often, determining the right imaging procedure is an involved discussion involving the patient, her family, and her family doctor, kidney doctor, and vascular surgeon. The pros of an angiogram include direct visualization into the artery of the kidney, with the ability to also treat the affected area in one procedure. The contrast dye used can affect the kidneys, but the amount of dye used can be minimal. The cons of an angiogram, on the other hand, include the fact that it is an invasive procedure, and that if an intervention is done, there can be complications to that procedure (see forthcoming section on angioplasty and stenting).
Treatment: Procedural Options
In addition to medical treatment, your doctor will likely also talk to you about performing a more invasive type of procedure if the stenosis to the artery is significant. This type of procedure first involves performing an angiogram as described above. Then, after the narrowed area is visualized, an angioplasty (angie-o-plas-tie), or opening up the narrowed area with a small balloon, is followed by the placement of a stent, or small tube to make sure the narrowed area stays open. Given the possible complications of this invasive procedure, it has not been promoted as a routine practice, with each situation carefully scrutinized and evaluated before any treatment is done.
Complications: Difficulties with Angioplasty and Stenting
If you remember, atherosclerosis refers to a plaque buildup that occurs along the walls of the blood vessels - a process that takes years. During the angioplasty, a process called embolization (em-boleis.zation) can occur. Here, a small piece or pieces of plaque can break off as a result of the balloon angioplasty. These small emboli can travel to smaller arteries of the kidneys and cause an acute inflammatory reaction. This can affect kidney function, and it is not an uncommon complication.
If the kidney function is advanced, it is often not clear-cut whether or not to proceed with the angioplasty. In some cases, placement of the stent may not improve the renal function. Given the risks of the procedure, most physicians will only consider this procedure in one of two situations: first, if the blood pressure is dangerously high despite multiple medications, and second, if there is only one functioning kidney and the blood flow to that kidney is severely compromised. There is an ongoing study that is looking at medical versus invasive treatment, and the results of this should be completed over the next few years. I tend to take a very conservative approach and only recommend an invasive approach when there are no other options.
There is a common theme; it is the dangerous effects of inflammation on the kidneys. Hypertension, diabetes, obesity, and atherosclerosis often occur together. The damaging effects of these four inflammatory conditions on the kidneys can worsen kidney function. Prevention in the forms of weight loss, lifestyle changes, and dietary improvements are important to preserve your kidney function. There are also standard treatment options, including medications and procedures, but they are not without their possible side effects; sometimes the treatments are even worse than the disease itself, so be sure to always maintain an open dialog with your doctor. To find out more, you can check out Treatment Chronic Kidney Disease.